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We recommend extension of the act for 2 years. By the end of fiscal year 1970, we expect the States to be dealing with migrant health problems as part of a larger program of continuing operations authorized and supported by the partnership for health.

In short, we believe that this separate program of assistance to migrant families is helping to overcome the inequalities in health care between them and the rest of the population, but that in the long run, true equality in health care will be realized only when their needs are not treated separately by the States.

THE ALCOHOLIC AND NARCOTIC ADDICT REHABILITATION

AMENDMENTS OF 1968

As introduced by the distinguished chairman of this committee, this bill will encourage the development of prevention and treatment programs for alcoholics and narcotic addicts in communities across the Nation.

This committee is well aware that the Community Mental Health Centers Act has already been beneficial to many of those suffering from mental illness and to their families, bringing treatment out of the remote custodial institutions into the community and making effective care available close to home. To date more than 260 mental health center grants have been awarded throughout the country. Eighty-five centers are now open.

We propose an amendment to this vital legislation in order to bring these same benefits of readily accessible care to those suffering from alcoholism and narcotic addiction, by providing special incentive grants for that purpose.

Mr. Chairman, it is estimated that some 5 to 6 million Americans can be classified as alcoholics-about 4.5 percent of the population aged 20 and over. Alcoholism, an enormous economic liability to the Nation, costs perhaps $2 billion a year in job absenteeism, lowered productivity, medical insurance expenses, and other losses. The damage in human terms is beyond measure-affecting not only the alcoholic but all those whose lives are touched by his illness.

Further, it appears likely that virtually all American communities shortly will be facing a major crisis in attempting to develop adequate medical, social, and psychiatric services for those alcoholics who formerly were handled almost exclusively by jails, prisons, and other penal institutions.

Two recent Federal circuit court decisions have stated that if a man's drunkenness is part of his illness-and this is a nonvoluntary act he should be treated as a sick person and not as a criminal. The U.S. Supreme Court will render its decision on a similar case later this spring.

Generally, neither the alcoholic, his family, nor the friend or counselor who wishes to help has any single place in the community to turn for the full range of services he needs. There are few integrated networks to provide the treatment and other services needed to restore him to a productive and satisfying life.

Therefore, Mr. Chairman, government at all levels has an obligation to accelerate the process that will make care and treatment accessible for these people. It is time that we provide the States and communities

with the incentives to enable them to meet this critical public health challenge.

This bill, building on the highly successful Community Health Centers Act, will amend that act to authorize special funds for the construction, staffing, and operation of facilities providing treatment for alcoholics.

The community mental health center approach is well suited for extension into this area of critical need, since it mobilizes the resources of the community in a program meeting the total mental health needs of its people. It helps to provide inpatient care, outpatient care, partial hospitalization, emergency service and communitywide services of consultation and education. It serves the full range of mental health needs—from the seriously ill patient to the person who can lead a normal, successful life with the aid of certain supporting services.

Clearly this is a highly appropriate model in which to integrate treatment and rehabilitation services for alcoholics. The centers are tuned to the community-the setting in which the alcoholic lives. They are involved in essential relationships with general hospitals, with public health departments, with social welfare agencies, with the courts, the schools, the vocational rehabilitation agencies, and also with other community sources of help such as doctors, lawyers, and clergymen.

It is now generally recognized that alcoholics and addicts are in urgent need of social, psychological, and medical assistance. Such assistance in treatment and rehabilitation should take its place in the mainstream of community mental health effort.

The proposed legislation authorizes grants for the construction of facilities for the prevention and treatment of alcoholism, and for their staffing, operation, and maintenance. These facilities are to be coordinated or associated with facilities providing comprehensive community mental health services.

For several reasons, we feel that a specific category of incentive grants for alcoholism should be authorized within the Community Mental Health Centers Act. First, alcoholism is a tragically longneglected major public health problem. It has received only limited attention for State and community helping agencies in the past, and the problem must now be highlighted.

Second, although community mental health centers have expressed interest in providing services for alcoholics, most of them have not yet taken substantial steps in this direction. They have had difficulty in developing services for these patients because community support for alcoholism programs has been lacking, because services for these patients are expensive, and because the patients frequently lack the means to pay for their own care.

Third, professional interest in providing treatment for alcoholics. has been limited thus far. These persons are difficult to treat, and special incentives are urgently needed for an interim period until alcoholics are accorded medical, psychiatric, and other types of treatment on an equal basis with other patients in need of help.

Two types of grant programs would be authorized by this legislation: Grants for construction, staffing, operating, and maintenance of general alcoholism treatment programs, and similar grants for specialized residential facilities for homeless alcoholics.

While those arrested for public drunkenness account for only a small proportion of any community's alcoholics, they do present a very substantial and highly visible problem. The proposed grants for residential and other special facilities for homeless alcoholics will go a long way toward providing help and hope for these persons who have in the past been handled primarily by the courts and police.

NARCOTIC ADDICTION

The problem of narcotic addicts likewise calls for special attention. The number of such addicts is relatively small in comparison with the 5 million or more alcoholics. The Bureau of Narcotics records some 62,000 who are addicted to narcotics, and there are unquestionably countless thousands who exist anonymously.

As in the case of alcoholics, there is today a grievous lack of adequate community services to provide care and treatment. The local community presently offers only minimal help. There is a pressing need for special funds for the construction, staffing, and operation providing treatment facilities, as well as for training of personnel, field trials, and demonstration projects related to improved treatment techniques. As in the case of alcoholism, there is a need for integrated treatment and rehabilitation services. Here, too, we believe the needs can be best met by building on the Community Mental Health Centers Act.

The proposed legislation would amend the Community Mental Health Centers Act by transferring to it the authorities now contained in section 402 of the Narcotic Addict Rehabilitation Act of 1966.

This section provides for project grants to States, communities, and nonprofit agencies for construction, staffing, and operation, and training of personnel for facilities for the treatment of narcotic addicts as well as related surveys and demonstrations.

The proposed transfer will not affect the relationship between this program and other activities authorized under the Narcotic Addict Rehabilitation Act.

Professionals have long believed that narcotic addiction is, to a great extent, a symptom of underlying mental illness, and therefore that recent advances in treatment and rehabilitation of the mentally ill should be extended to the addict. The Narcotic Addict Rehabilitation Act of 1966 was an important step in advancing this concept.

Let me describe briefly the program envisioned in such a narcotic addiction treatment center.

A model comprehensive treatment program would provide care for approximately 400 narcotic addicts per year. Such a program would include a 10- to 12-bed inpatient unit to be used for withdrawal. Residential treatment or partial hospitalization services, such as day care, would be another element of the program.

Outpatient treatment and followup services, including rehabilitative, vocational, or educational programs, would also be provided. Preventive and diagnostic services should also be provided either directly or through cooperation with other community agencies.

A halfway house or residential treatment center located in the community would house 30 to 40 patients. One or two outpatient facilities connected with each center would serve addicts and their families and would be staffed by two or three mental health professionals, a

vocational rehabilitation counselor, a community organizer, two trained ex-addicts, and five other persons, such as nurses or social workers.

An evaluation and epidemiologic unit to study the extent and characteristics of that community's addiction problem might be another component.

Mr. Chairman, the proposed amendments to the Community Mental Health Centers Act are intended to strike at the roots of an intensely tragic situation. In most American communities, alcoholics and narcotic addicts and their families who suffer with themhave few places to turn for professional help. Yet many of these people could be restored to productive living if such help were within reach. Community mental health centers will be operating in cities with a high incidence of alcoholism and narcotic addiction. However, the Community Mental Health Centers Act now offers no special inducement to centers wishing to attack these critical and difficult problems. The proposed grant program is intended to provide the necessary stimulus and the capability to do the job.

In addition, the amendments before this committee today will serve as a model for the States in developing and modifying their own community mental health, alcoholism, and addiction legislation.

This committee, by recognizing the importance of incorporating facilities for the prevention and treatment of alcoholism and narcotic addiction into the community mental health center complex, will make a vital contribution toward achieving prevention and control of these major public health problems.

I would like to insert in the record two tables, showing participation in the regional medical program, and total obligation of funds. (The documents referred to follow :)

TABLE I.-Participation in regional medical programs by individuals and organizations

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Other professional societies, local voluntary agencies, etc--

1 100 percent participation.

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TABLE II.-Regional medical programs, total obligation of funds

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Dr. LEE. Thank you, Mr. Chairman, for this opportunity to explain to this subcommittee our views on H.R. 15758. Mr. Huitt, Dr. Marston, Dr. Yolles, and Miss Johnston will be happy to answer any questions you may have.

Mr. ROGERS. Thank you very much, Dr. Lee, for your statement covering the proposed legislation. I think we will start our questions by Mr. Kyros.

Mr. KYROS. Thank you, Mr. Chairman.

I want to commend you, Dr. Lee, on a very excellent statement and to welcome you here. I would like to start with the last thing you said on page 18 of your statement.

How will community mental health center completions, where you will have facilities for treatment of alcoholism and narcotic addiction, make a vital contribution toward preservation of such problems? Dr. LEE. I would like to ask Dr. Yolles to comment on that, and then I will comment also.

Dr. YOLLES. The prevention referred to in terms of these programs, which are primarily pointed to treatment of alcoholics and addicts, refers to secondary prevention. The secondary prevention approach is, in effect, early intervention to prevent further pathology from occurring.

We would hope that the preventive aspects-education, consultation with other agencies, would be handled under other legislation, Public Law 89-749, the Partnership for Health Act, which also will deal with these problems.

Mr. KYROS. Will these centers be similar to some of the mental health centers in Massachusetts? Will they treat people as outpatients?

Dr. YOLLES. Depending on the type of case, you may have a variation in types of treatment. If someone came in in an acute state, he would be hospitalized, generally in a general hospital, and then go on to perhaps transitional day care or night care and then outpatient care, and followup thereafter.

Mr. KYROS. Let me ask a question generally about the regional medical program.

As I understand it, it has been in operation nearly 2 years, is that right?

Dr. LEE. That is correct.

Mr. KYROS. Have you been able to make qualitative analysis on whether this program has made knowledge of medical science available to practitioners in rural areas?

Dr. LEE. Yes; I think we can cite examples. I would like to emphasize that the efforts until now, of course, have been primarily bringing the various groups together, building the foundation on which the operational programs will be moving forward rapidly.

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